Case 003

History/Physical

History/Physical:

40-year-old right-handed male.

Neck pain and stiffness for 18 months.

The unenhanced coronal T1 sequence shows a large mass within the 4th ventricle (arrows). The lesion has the same signal intensity as adjacent brain.

Post-contrast, the mass shows foci of curvilinear enhancement (*). These are likely small normal entrapped vessels. The mass itself shows no significant enhancement (arrows).

On T2, the mass (*) is slightly hyperintense compared with the adjacent medulla and cerebellum. The tiny round areas of low signal are small arteries and veins (arrowheads).

The mass (*) is expanding the 4th ventricle. Despite the large size of the mass, there is no edema in the adjacent brain.